Air Embolism

Between patient and blood pump, due to high negative pressure and leaks in the circuit in this segment

Air in the dialysate fluid (uncommon, mostly gets trapped in venous chamber)

During central venous catheter insertion or removal

Upright body position and hypovolemia, both by reducing venous pressure, are significant contributing factors

Treatment

Prevent further air entry by clamping and disconnecting the circuit

Flat supine position may be better over traditionally advocated left lateral (Duran’s position) and Trendelenburg position1,2

Oxygen with FiO2 100%

Hyperbaric oxygen3 (prevents cerebral edema)

Use of Luer-lock syringes for blood draw from catheters

Prevention

Test machine prior to use to ensure that the air detector alarm system is working effectively

Catheter insertion or removal should be in a head low position (insertion site 5 cm below right atrium). Patient can assist by holding their breath or doing a Valsalva maneuver that will increase central venous pressure4.